> For the complete documentation index, see [llms.txt](https://docs.snomed.org/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://docs.snomed.org/snomed-ct-specifications/snomed-ct-editorial-guide/readme/authoring/domain-specific-modeling/procedure/index-2/stoma-procedures.md).
# Stoma procedures
A distinction is needed between stoma procedures and procedures where an anastomosis is created between two hollow organs.
A stoma is a surgically created opening connecting an internal body structure to the external skin surface. Although most commonly formed on the abdominal wall, stomas can be created at other anatomical sites, such as the neck (tracheostomy) or perineum (perineal urethrostomy). The defining criterion is cutaneous externalization.
In contrast, internal anastomoses between two visceral structures, such as an entero-enterostomy or ureterointestinal anastomosis, while often referred to as *internal stomas* are not classified as stomas, as they lack cutaneous communication or exteriorization.
The morphologies resulting from these two different types of procedures may both be termed using the suffix *ostomy*, but they mean different things:
* For example,
* 272726003 |Gastrostomy (morphologic abnormality)| refers to the result of the exteriorization of the stomach through the abdominal wall.
* 264022007 |Ileocolostomy anastomosis (morphologic abnormality)| refers to the anastomosis between the ileon and the colon.
{% hint style="danger" %}
These two different types of morphologies were formerly termed *external stomas* and *internal stomas*. Procedures and Morphologic abnormalities named *internal* and/or *external stoma* are no longer allowed in SNOMED CT.
{% endhint %}
## Naming
FSN: X -ostomy (procedure)
PT: X -ostomy
Acceptable SYN:
* Construction of X -ostomy
* Construction of stoma of x \
* Construction of X \ stoma
For example,
* FSN: Colostomy (procedure)
* PT: Colostomy
* SYN: Construction of colostomy
For the FSN, the terms *construction*, *creation*, and *formation* are not allowed.
The term *construction* can be used for Acceptable synonyms.
#### Combination of procedures
When the FSN states a combination of procedures, the concept is termed using the conjunction “with”.
* For example,
* 89642006 |Anterior resection of rectum with colostomy (procedure)|
* 307658004 |Sigmoid colectomy with colostomy (procedure)|
When an FSN states the combination of more than two procedures, use the conjunction “with” for the first two procedures, and use the conjunction “and” for the third procedure.
* For example,
* 44751009 |Total abdominal colectomy with proctectomy and continent ileostomy (procedure)|
#### Closure of stoma
FSN: Closure of x \-ostomy
PT: Closure of x \-ostomy
Acceptable SYN:
* Closure of stoma of x \
* Take-down of x stoma
* Take-down of stoma of x \
For example,
* FSN: Closure of gastrostomy (procedure)
* PT: Closure of gastrostomy
* SYN: Closure of stoma of stomach
* SYN: Surgical closure of gastrostomy
* Take-down of stoma of stomach
## Modeling
### Stoma procedures without statement of the exteriorization site
Role group:
* 260686004 |Method (attribute)| = 129354008 |Exteriorization - action (qualifier value)|
* 405813007 |Procedure site - Direct (attribute)| = < 123037004 |Body structure (body structure)|
* 363700003 |Direct morphology (attribute)| = << 245857005 |Stoma (morphologic abnormality)|
For example,
### Stoma procedures with stated exteriorization site
Role group:
* 260686004 |Method (attribute)| = 129354008 |Exteriorization - action (qualifier value)|
* 405813007 |Procedure site - Direct (attribute)| = < 123037004 |Body structure (body structure)|
* 363700003 |Direct morphology (attribute)| = << 245857005 |Stoma (morphologic abnormality)|
* 116688005 |Procedure approach (attribute)| = < 103379005 |Procedural approach (qualifier value)|
For example,
{% hint style="info" %}
Surgically created internal anastomoses or connections between two internal organs are not considered for this guidance as they are part of another hierarchy.
{% endhint %}
### Closure of stoma
Role group:
* 260686004 |Method (attribute)| = 129357001 |Closure - action (qualifier value)|
* 405813007 |Procedure site - Direct (attribute)| = < 123037004 |Body structure (body structure)|
* 363700003 |Direct morphology (attribute)| = << 245857005 |Stoma (morphologic abnormality)|
For example,
---
# Agent Instructions
This documentation is published with GitBook. GitBook is the documentation platform designed so that both humans and AI agents can read, navigate, and reason over technical content effectively. Learn more at gitbook.com.
## Querying This Documentation
If you need additional information that is not directly available in this page, you can query the documentation dynamically by asking a question.
Perform an HTTP GET request on the current page URL with the `ask` query parameter, and the optional `goal` query parameter:
```
GET https://docs.snomed.org/snomed-ct-specifications/snomed-ct-editorial-guide/readme/authoring/domain-specific-modeling/procedure/index-2/stoma-procedures.md?ask=&goal=
```
`ask` is the immediate question: it should be specific, self-contained, and written in natural language.
`goal` is optional and describes the broader end goal you are ultimately trying to accomplish on behalf of the user. GitBook uses it to tailor the answer towards what is most useful for that goal.
The response will contain a direct answer to the question and relevant excerpts and sources from the documentation.
Use this mechanism when the answer is not explicitly present in the current page, you need clarification or additional context, or you want to retrieve related documentation sections.